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For 20 years Joan* quietly suffered from an unrelenting desire to commit suicide. She held down a job as a special-education teacher and helped care for her family in the northeastern U.S. Yet day after day she struggled through a crushing depression and felt neither joy nor pleasure. Except for the stream of psychiatrists recommending different antidepression treatments—all of which failed to provide relief—Joan kept her condition private. She says it was the fear of hurting her students or abandoning her father that kept her alive. “I really don't know how I survived,” she says.

A few years ago Joan got a break. She came across a clinical trial for a drug called ketamine that had succeeded in treating patients with intractable major depressive disorder. She enlisted. Following one dose, she experienced her first reprieve from suicidal thoughts in two decades. She realized the drug was working while she was sitting outside on a pleasant day and noticed that the leaves on a tree looked bright green and that a spider was building a web. “It sounds crazy, but normally everything was clouded and gray,” she says. “Nothing stirred me.”